Ignore ‘Nanny State’ critics and expand sugar taxes, ban sale of energy drinks to under 16s, and roll out national supervised toothbrushing programme in schools to tackle the crisis of tooth decay affecting millions of children – Child of the North/Centre for Young Lives report

• Latest joint report from Child of the North and the Centre for Young Lives calls for a new evidence-based national strategy to improve the oral health of children in England.
• Report urges Ministers to be radical and use sugar taxes, energy drink bans, targeted supervised tooth-brushing in nurseries and schools, and an expansion of fluoridation.  
• Report shows tooth decay affects millions of children in England, with fewer than four in ten children having good oral health and one in ten 3-year-olds already suffering from tooth decay. In 2023, only half of children had visited an NHS dentist within the recommended maximum period of 12 months. For under-fives it was less than a third.  
• Report highlights specific challenges in the North of England. In the North East and Yorkshire one in five Year 6 primary school children and a third of Year 7 and Year 8 secondary school children have experienced tooth decay in their permanent teeth.

[.download]Download the Report[.download]

A new report published today (Friday) by Child of the North and Anne Longfield’s Centre for Young Lives think tank, “An evidence-based plan for improving children’s oral health with and through educational settings”, makes a series of new proposals to tackle the children’s oral health crisis in England which is seeing millions of children suffering from tooth decay.  

The report calls on the new Government to develop a national child oral health strategy and makes recommendations to reduce sugar consumption among children, optimise fluoride exposure, and increase access to dental care. It is the eighth in a series of Child of the North/Centre for Young Lives reports published in 2024 focusing on how the new Government can put the life chances of young people at the heart of policy making and delivery.

Today’s report reveals the substantial and wide-ranging extent of tooth decay affecting millions of children and young people in England, and its impact on their quality of life. Untreated disease can cause toothache, sleepless nights, and altered eating habits, and may also impact negatively on the development of speech and language. Poor oral health can lower confidence and affected children may be less likely to reach their developmental potential. There is also evidence to suggest that even when accounting for the different levels of tooth decay, the burden of tooth decay on the lives of children living in deprived areas is more severe.

New analysis included in the report reveals that when school readiness was explored by researchers in Bradford, as part of the Born in Bradford project, children who were not considered school ready were more likely to have tooth decay compared to those who were school ready.

The report sets out the alarming scale of the children’s oral health crisis, particularly in the North of England:

• Overall, fewer than four out of ten children in England have good oral health.  
• One in ten 3-year-olds in England already have tooth decay, rising to three in ten by the age of five.
• One in five Year 6 school children in North East England and Yorkshire have experience of tooth decay in their permanent teeth.  
• Research involving Year 7 and Year 8 children from deprived areas in the North of England, Scotland and Wales has found that over one-third had tooth decay in their permanent teeth. Four in ten reported that their oral health had an impact on their daily lives.
• Families living in deprived areas are more than twice as likely to have tooth decay, and there are much higher levels of tooth decay in children in the North compared with elsewhere in England.
• Tooth decay is also the most common reason for hospital admission in 5-to-9-year-olds.
• In 2023, only half of children had visited an NHS dentist within the recommended maximum period of 12 months. For under-fives it was less than a third.
• Last year, 27,000 children in England were on NHS waiting lists for dental care by specialists, with 12,226 children on waiting lists for dental procedures under general anaesthetic with average waiting times of up to 80 weeks.

The report recommends the new Government develops and implements a national child oral health improvement strategy to improve children’s oral health and reduce social inequalities, particularly those experienced by children and young people in the North of England. This would be overseen by a national board including representatives from government departments, local government, dental organisations and specialist societies, universities, citizen representatives, and charities. This strategy would include:

• Reducing sugar consumption through policy action such as expanding the Soft Drinks Industry Levy to include other sugar-sweetened beverages such as sugary milk drinks.  
• Applying restrictions on food marketing, advertising and promotions.
• Banning the sale of caffeinated energy drinks to under 16-year-olds.  
• Optimising exposure to fluoride through a combination of community water fluoridation and increasing the number of targeted programmes such as supervised toothbrushing.

The report sets out proposals to maximise the impact of early years and education-based interventions, co-designed by health visitors, nurseries, and schools.

It also calls for dental services to be re-orientated towards prevention of dental diseases among children and young people. This would mean:

• Working with the dental profession, dental system reform, and innovative commissioning - led by integrated care boards (ICBs) - to provide opportunities to prioritise improving dental services for children, particularly for those with additional needs.  
• Better mechanisms for allocation and distribution of funding based on need, and consideration of providing dental services with and through schools and nurseries.  
• A renewed emphasis on clinical prevention, including better use of fluoride treatments, dental sealants and behaviour change interventions to support families’ and children’s oral health behaviour.  

The report highlights innovative approaches which are already addressing children’s oral health problems. It sets out how local government has a key role to play in reducing sugar consumption and many local authorities have their own strategies to reduce consumption of foods and drinks high in fat, sugar, and salt.

The report showcases interventions like Sheffield’s Sweet Enough, a five-year initiative commissioned by Sheffield City Council to support residents' understanding of the harms of consuming too much sugar, working in the most deprived areas, and HABIT, a public health intervention to support health visitors and their wider team to have effective oral health conversations with parents of infants in Bradford.

It also highlights projects like the BRIGHT trial, a behaviour change intervention to promote toothbrushing in secondary school children, Liverpool’s Smile Squad Initiative, a collaboration between the University of Liverpool Paediatric Dentistry team, a local dental practice and the Liverpool Football Club Foundation, and RAISED In Yorkshire, co-created with Year 12-13 students, which offers oral health lessons to Year 7 pupils. Recently qualified dental professionals train Year 12 students, who in turn deliver teaching to pupils in local schools about the importance of oral health.

Anne Longfield, Executive Chair of the Centre for Young Lives, said:

“It is staggering that so many children, particularly in the North of England and those living in low income families, are now growing up with tooth decay and suffering from toothache and discomfort. This can affect their quality of life, sleep patterns, eating habits, and impact on school readiness and attendance, speech and language development, and overall confidence. In some areas it has sadly become the norm.

“Many children are not only missing out on NHS dental healthcare but are more likely to suffer tooth decay from a younger age.

“The Government’s proposals for a programme of supervised teeth-brushing in schools is a positive step forward, as is its overall focus on boosting children’s wellbeing.

“We urge Ministers to be radical, go much further, and ignore any accusations of a ‘nanny state’. We need to take evidence-based action and to develop a national plan to tackle a rotten teeth crisis affecting millions of our children.”

Paula Waterhouse, President of the British Society of Paediatric Dentistry, said:

“This report reveals how higher levels of deprivation and associated unmet dental need are more seriously impacting children and young people living in the North of England compared with their southern counterparts.

“It is time to establish an oral health strategy for children and young people across England. The evidence base garnered by existing oral health research should be used to inform Government strategy and implementation of both national and local policies.  

“We need to act now. Our children’s health depends on it and it’s everybody’s business – parents, dental and medical teams, health visitors, industry, education colleagues, and policy makers. We all have a part to play.”

Mark Mon-Williams, Child of The North report series editor, said:

“Toothache is caused primarily by decay and the rotten teeth of the next generation provide a stark reminder of the perilous state of the nation’s health.

“The pain of toothache is excruciating and the most brilliant teacher in the world will struggle to educate a child experiencing dental disease.

“The time has come for the UK to start taking its future seriously - and helping ensure that all children throughout the UK have a smile on their face seems a pretty good place to start.”

Camilla Kingdon, Immediate Past President of the Royal College of Paediatrics and Child Health, said:

“I am really thrilled with this report because the state of our children’s teeth should be a source of national embarrassment.

“This shows that there is so much that can be done to tackle the problem. The many spin offs of a robust national strategy to improve children’s oral health would be potentially significant - benefits for tackling obesity as well as mental health issues, and potentially improving school attendance, amongst other things.

“The impact of poor oral health stretches way beyond childhood and so every one of us should see this as a key health promotion and disease prevention strategy that benefits the whole nation.”  

Report co-author Zoe Marshman, Professor of  Dental Public Health at the University of Sheffield, said:

"Treatment for tooth decay is the most common reason why young children - over 33,000 youngsters each year - are admitted to hospital, costing the NHS over £40 million every year.

"In deprived areas of the country up to 50 per cent of five-year-olds have tooth decay which causes pain and suffering, as well as affecting what children eat, their speech, sleep, quality of life and attendance at school.

"This report shines a spotlight on the impact of poor dental health on children's lives and recommends a new national strategy to focus attention on providing much needed solutions.”

Report co-author Peter Day, Professor of Paediatric Dentistry, University of Leeds and Community Dental Service, Bradford District Care NHS Foundation Trust said:

“I welcome the opportunity to write this report with colleagues across the North of England and shine a light on children’s oral health. As a paediatric dentist, I see the impact of tooth decay on children every day in my clinic. There is still much to do. This report lays out strong evidence for what works. We need to reorient and coordinate national and local public services towards prevention and ‘turn the taps off.’ All children deserve the best start in life, and this includes having a healthy set of teeth.”

ENDS

[.download]Download the Report[.download]

For further information and requests for media interviews, please contact Jo Green: jo.green@centreforyounglives.org or 07715105415.

Notes to editors:

1. The report can be accessed here: https://centreforyounglives.org.uk/report/CotN_Oral-Health_Report_8.pdf‍
2. Today’s report has been produced by eight research intensive universities in the North of England – the N8 Research Partnership – in collaboration with a wider academic community (the N8+) as part of the Child of the North initiative, and the new Centre for Young Lives think tank, founded in January 2024 by former Children’s Commissioner Anne Longfield. It is the eighth in a series of Child of the North/Centre for Young Lives reports to be published during 2024 looking at how to encourage the Government to set out a vision for children and show how putting the interests and life chances of young people at the heart of policy making and delivery is crucial to Britain’s future success. They shine a light on some of the biggest challenges facing the Government while also providing rigorous research and pragmatic, evidence-based recommendations which acknowledge the ongoing financial limitations on government spending. Seven principles will be a theme throughout the twelve reports: the Government must “put children first”; inequality must be addressed; place-based approaches must be adopted; public services must work together more effectively; education must be at the heart of public service delivery; universities must become the ‘research and development’ departments for local public services; and information must be shared across public service providers and used effectively.
3. Child of the North is a partnership between the N8 Research Partnership and the Northern Health Science Alliance / Health Equity North and includes partners from across the North of England. Its vision is to develop a platform for collaboration, high-quality research, and policy engagement to support fairer futures for children living in the North of England. The N8 Research Partnership is a strategic collaboration between the universities of Durham, Lancaster, Leeds, Liverpool, Manchester, Newcastle, Sheffield, and York, and aims to maximise the impact of this research base to enable business innovation and societal transformation. The N8 universities receive around 80% of competitively awarded research funding in the North of England, and employ more than 18,000 academic staff, forming the largest research-pooling partnership in the UK. N8 creates programmes involving a critical mass of world class academics which form networks of innovation excellence with partners in other sectors, to drive investment and economic growth.
4. Health Equity North is a virtual institute focused on place-based solutions to public health problems and health inequalities across the North of England. Health Equity North brings together world-leading academic expertise from the Northern Health Science Alliance membership of leading universities, hospitals, and academic health science networks, with the aim of fighting health inequalities through research excellence and collaboration.